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Reduce Child Mortality: Serving the Underserved in Laos

From: International Year of the Nurse

Published:

Rodelia Busalpa, RN, BSN, and family nurse practitioner (FNP) student, credits Samuel Merritt College (SMC) with preparing her for a recent class trip to Southeast Asia. She and a dozen fellow FNP students who attend SMC's Sacramento Regional Learning Center in Sacramento, California, went on a two-week mission to local hospitals, orphanages and villages in and around Vientiane, the capitol of Laos. The students helped provide free health care for Hmong residents of those villages.

"The villages were very primitive. The traditional homes were made out of bamboo and soil, with no floor, no compartments; everyone slept in one room," said Busalpa. "No electricity, no running water, kids running around the village with no shoes. It's just a different way of living. Many of us were surprised to find people still live like this."

Despite the poor conditions, Busalpa feels the college prepared her and the other students for what they were going to encounter.

"We took a course in Sacramento with Terry Deane, RN, MSN, MBA, FNP, assistant professor at Samuel Merritt College School of Nursing, about integrating cultural aspects into health care for the underserved, along with community health," said Busalpa. "We read The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. At first, I didn't understand the importance of it but, when I came here, it all clicked. Basically, it's an understanding that we are not dealing with one culture, and we must recognize and respect what villagers practice and believe." "Cultural understanding is in the nurse practitioner curriculum," said Associate Professor Valerie Dzubur, EdD, FNP-C. "It's important to understand the differences between cultural context for other people than ourselves. It's a great way to see and respond to the challenges. It's practical application, which is what nursing is all about."

"The students were fabulous. In our culture, they feel like novices, but in the developing world, they are already experts." -Valerie Dzubur

Once the group became a part of the community, observed Dzubur, they were able to gain a deeper understanding of the hardships villagers face on a daily basis. She noted that their economic challenges create several health care concerns, including Vitamin A deficiency.

"Night blindness is one of the first signs of vitamin A deficiency," said Dzubur. "Vitamin A deficiency also diminishes ability to fight infections, decreases growth rate and slows bone development. In countries where children are not immunized, infectious diseases like measles have relatively higher fatality rates."

Evelyn Shober, an FNP student, said that, despite the limited clinical care they were able to provide, the group's presence helped in many ways.

"We did mouth exams, listened to lungs," said Shober, "but I think just walking in a room with our stethoscope and putting our hands on someone gave some people a sense of comfort knowing that we wanted to help."

"The average age in the village was 40 to 50 years," said Busalpa. "Half of the health problems you see here in the United States, you don't see there. For us, it's heart disease and cancer. Many of the villagers [in Laos] deal with tuberculosis, hepatitis, and malaria. Those things are not common here."

Along with providing free medical checkups and supplies, the program supports the community in other ways. Assistance from the Windhorse Foundation has helped build a preschool, sponsor an orphanage and purchase land for farming projects. Money donated by the foundation and Samuel Merritt College provided the FNP group the resources to buy a gurney and a microscope for the local public hospital. It took a 12-hour bus ride through windy mountain roads to deliver the new medical equipment.

"To buy the gurney made me so proud," said Shober. "Dr. Dzubur has worked with this hospital before, and they were so happy to receive it. I felt in awe to be taught by a professor who was recognized all over the world for her humanitarian work."

The hospital itself was an eye-opening experience for many of the students.

"You see 20 to 30 patients sleeping in one room with no privacy," said Shober. "They lay on a thin, foam mat. IV poles are made out of wood. Doctors take turns in the operating room, and the table is held up by wooden planks. We take so much for granted here in the U.S."

"The nurses at the hospital held us in high regard," said Busalpa. "Nurses in the U.S. have more education and responsibility then they have there."

"The students were fabulous," said Dzubur. "In our culture, they feel like novices, but in the developing world, they are already experts. To experience their competence, to use their education, especially at this stage, is really important to build confidence and give them a sense of the gift of their own education."

The trip is part of Dzubur's new course, "Interpreting Health Care in a Global World." The one-unit elective is an opportunity for FNP students to travel to places like Laos and Thailand to develop cultural understanding in international health care. The FNP program has an emphasis on meeting the needs of multicultural and underserved populations.

"That is why I chose SMC, because of this commitment to serve the underserved," said Shober. "Schools like UCSF [University of California, San Francisco] are great medical campuses and a university, but SMC's commitment to the underserved and the fact that faculty go out there and start clinics and work in underserved communities is right up my alley. I look forward to next year's trip."

Students, faculty members and friends of Samuel Merritt College provided funding for the trip. The college, founded in 1909, has been educating health professionals for nearly 100 years. RNL Elizabeth Valente is associate director of publications and media relations at Samuel Merritt College, Oakland, California, USA. Photos by Rhonda Ramirez.